17-098.01 HDR Engineering: Pines BNSF Grade SeparationA111111111111111►
Washington State
WAf Department of Transportation
Supplemental Agreement
Organization and Address
Number 01
City of Spokane Valley
10210 E. Spraguc Avenue
Original Agreement Number
Spokane Valley, WA 99206
17-098
Phone: 509-720-5000
Project Number
Execution Date
Completion Date
0223
07/27/17
12/31/19
Project Title
New Maximum Amount Payable
Pines Road/BNSF Grade Separation Project #0223
$124,349.85
Description of Work
To improve safety by developing a grade separated facility at the intersection of Pines Rd and the BNSF Railway railroad tracks.
Other major work associated with this project includes modifications to the intersection of Pines Rd and SR290 (Trent Ave) and
closing the Pines/BNSF and University/BNSF Railway at -grade intersections in the City of Spokane Valley, Washington. The
design development will expand on the Concept Design and Plans prepared as part of the Bridging the Valley project completed in
2004.
The Local Agency of city of Spokane Valley
desires to supplement the agreement entered in to with HDR Engineering, Inc.
and executed on 07/27/18 and identified as Agreement No. 17-098
All provisions in the basic agreement remain in effect except as expressly modified by this supplement.
The changes to the agreement are described as follows:
Section 1, SCOPE OF WORK, is hereby changed to read:
No change.
11
Section IV, TIME FOR BEGINNING AND COMPLETION, is amended to change the number of calendar days
for completion of the work to read: Contract completion date is revised to 12/31/19
III
Section V, PAYMENT, shall be amended as follows:
No change.
as set forth in the attached Exhibit A, and by this reference made a part of this supplement.
If you concur with this supplement and agree to the changes as stated above, please sign in the Appropriate
spaces below and return to this office for final action.
Q
By: UL I ' JE1M E Z By:
Consultant Signature Approving Authority Signature
l2 -z
Date
DOT Form 140.063
Revised 09/2005
Page 1 of 2
� ®
ACERTIFICATE OF LIABILITY INSURANCE
l`....'
DATE (MMIDYY)
05/18/2012018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pol(cy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
Willis of Minnesota, Inc.
26 Century Blvd
P.O. Box 305191
Nashville, TN 372305191 USA
CONTACT
NAME:
PHCNEo E 1-877-945-7378 FAX
No:1-888-467-2378
(Alc/o
EMAIL
ADDRESS: certificates@willis.com
INSURERS AFFORDING COVERAGE NAIC#
INSURER A: Liberty Mutual Fire Insurance Company 23035
INSURED
INSURER B: Liberty Insurance Corporation 42404
INSURER C:
HDR Engineering, Inc.
8404 Indian Hills Drive
Omaha, HE 68114
INSURER D:
INSURER E :
INSURER F:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY a E� � LOC
P
____--.....
n[:�nc1AA1 Ai1111IIDCD•
COVERAGES tr CIC I Ir I%11A 1 C Irumocn. ' ---' ---
THIS IS TO CERTIFY THAT THE POLICIES OF -INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE. POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRADDL
LTR
A
TYPE OF INSURANCE
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
X Contractual Liability
Y
SUBR
y
POLICY NUMBER
TB2-641-444950-038
POLICY EFF
MM/DD/YYYY
06/01/2018
POLICY EXP
MM/DD/YYYY
06/01/2019
LIMITS
EACH OCCURRENCE S 2,000,000
DAMAGETOWERTEU1,000,000
PREMISES Ea occurrenceS
MED EXP (Any one person) S 10,000
PERSONAL&ADV INJURY S 2,000,000
GENERAL AGGREGATE S 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY a E� � LOC
P
PRODUCTS 4,000,000
S
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident)S 2,000,000
BODILY INJURY (Per person) S
A
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
Y
Y
AS2-641-444950-048
06/01/2018
06/01/2019
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident
$
B
I�D�ED
LALIAB
LIAB
X
OCCUR
CLAIMS -MADE
Y
Y
TH7-641-444950-068
06/01/2018
06/01/2019
EACH OCCURRENCE $ 5,000,000
AGGREGATE S 5,000,000
B
RETENTION 5
WORKERS COMPENSATION
X STATUTE ERH
E.L. EACH ACCIDENT $ 1,000,000
B
AND EMPLOYERS'LIABILITY YIN
ANYPROPRIETORIPARTNER/EXECUTIVE No
(Mandatory In EREXCLUDED7
(MandatoryInNH)
,,yes describe under
DESCRIPTION OF OPERATIONS below
NIA
Y
WA7-64D-444950-018
06/01/2018
06/01/2019
E.L. DISEASE - EA EMPLOYEE S 1,000,000
E.L. DISEASE- POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
Re: City of Spokane Valley Pines Road BNSF Grade Separation (CIP #0223).
Certificate Holder is named as Additional Insured on General Liability, Automobile Liability and Umbrella Liability on
a primary, non-contributory basis where required by written contract. Waiver of Subrogation applies on General
Liability, Automobile Liability, Umbrella Liability and Workers Compensation where required by written contract.
Umbrella policy follows form of the underlying General Liability, Automobile Liability; Employers Liability.
CERTIFICATE HOLDEK
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Spokane Valley
Attn: Jim Dingfield AUTHORIZED REPRESENTATIVE
11707 E Sprague Avenue
Suite 106' A
Spokane Valley, WA 99206 ...moo nose nrnon rnDDnRATIfHJ All rinhfc rP zPrvPd_
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
SR ID: 16178775 BATCH: 715012